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Ultrasound in obstructive lung diseases: the effect of airway obstruction on diaphragm kinetics. A short pictorial essay

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Abstract

The ultrasound study of the chest is showing a continuous development. This technique could be helpful in managing several chest diseases, but it is limited to the acoustic windows provided by intercostal spaces and by the inability to study healthy lung parenchyma and all intra-parenchymal diseases such as chronic obstructive lung disease (COPD), because the interaction between ventilated lung and ultrasound generates only artifacts. Currently, there are few applications of ultrasound that are useful in COPD, with recent studies providing some innovation potentially useful in clinical practice. The similarity of the trend between the time/volume curve of spirometry and the M-mode representation of diaphragm during forced breath allowed to identify the M-mode Index of Obstruction (MIO), an index obtained from the ratio between forced diaphragmatic excursion in the first second (FEDE1, cm) and the maximal expiratory diaphragmatic excursion (EDEMax, cm). MIO has shown a linear correlation with the ratio between forced expiratory volume in the first second (FEV1) and vital capacity (VC), used in spirometry to identify airways obstruction. The value of MIO seems to be lower in patients affected by airways obstruction as showed by a recent study. The technique is easy to learn and fast to perform and the analysis could be provided with any ultrasound machine equipped with M-mode. In conclusion, these findings, if confirmed by other studies, could suggest a new add-on screening tool for obstructive lung diseases, in particular COPD, that could be performed during a routine abdominal ultrasound exam.

Riassunto

Lo studio ecografico del torace sta conoscendo un crescente sviluppo. Questa tecnica può essere di aiuto nella gestione di svariate patologie del torace, ma è limitata alle finestre acustiche fornite dagli spazi intercostali e dall’incapacità di studiare il parenchima polmonare sano e tutte le patologie intraparenchimali come la Broncopneumopatia Cronica Ostruttiva (BPCO), poiché l’interazione tra il polmone ventilato e gli ultrasuoni genera solo artefatti. Attualmente, ci sono poche applicazioni dell’ecografia fruibili nella BPCO, e alcuni studi recenti forniscono degli spunti innovativi potenzialmente utili nella pratica clinica. La somiglianza dell’andamento della curva spirometrica volume/tempo e della rappresentazione ecografica in M-mode della cinetica diaframmatica durante una manovra di espiro forzato ha consentito di identificare l’Indice di ostruzione in M-mode (MIO), un indice ottenuto dal rapporto tra l’escursione diaframmatica forzata nel primo secondo (FEDE1, cm) e l’escursione diaframmatica espiratoria massimale (EDEMax, cm), mostra una correlazione con il rapporto tra il volume espiratorio forzato nel primo secondo (FEV1) e la capacità vitale (VC), utilizzato nella spirometria per identificare l’ostruzione delle vie aeree. Il valore di MIO sembra essere inferiore nei pazienti affetti da ostruzione della vie aeree come evidenziato da uno studio recente. La tecnica è facilmente apprendibile ed eseguibile e l’analisi può essere ottenuta con qualunque ecografo dotato di M-mode. In conclusione, questi riscontri, se confermati da altri studi, potrebbero suggerire una nuova ulteriore tecnica di screening per le patologie ostruttive, in particolare la BPCO, che potrebbe essere eseguita durante una ecografia addominale di routine.

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Conflict of interest

Alessandro Zanforlin, Andrea Smargiassi, Riccardo Inchingolo, Salvatore Valente, and Emilio Ramazzina declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. All patients provided written informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.

Human and animal studies

The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.

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Authors and Affiliations

  1. SOC Medicina, Ospedale San Luca, viale prof. Ugo Grisetti 265, 45027, Trecenta (Ro), Italy

    Alessandro Zanforlin & Emilio Ramazzina

  2. UOC Pneumologia, Policlinico “A. Gemelli”, Università Cattolica del Sacro Cuore, Corso Agostino Gemelli 8, Roma, Italy

    Andrea Smargiassi, Riccardo Inchingolo & Salvatore Valente

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  1. Alessandro Zanforlin
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  2. Andrea Smargiassi
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  3. Riccardo Inchingolo
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  4. Salvatore Valente
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  5. Emilio Ramazzina
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Correspondence to Alessandro Zanforlin.

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Zanforlin, A., Smargiassi, A., Inchingolo, R. et al. Ultrasound in obstructive lung diseases: the effect of airway obstruction on diaphragm kinetics. A short pictorial essay. J Ultrasound 18, 379–384 (2015). https://doi.org/10.1007/s40477-014-0122-5

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  • DOI: https://doi.org/10.1007/s40477-014-0122-5

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